Introduction

Physician income overall is on the rise again in almost every specialty, reversing a decline in compensation during the past several years. Eight specialties earned a mean of at least $300,000 last year, and primary care physicians also posted gains.

Doctors aren't ready to break out the champagne just yet, though. Frustration with medical practice is also on the rise, and physicians are making changes in their practice by adding ancillary services, moving toward employment, and scrutinizing their payers, as doctors keep an eye toward the bottom line.

"The main dynamic behind rising income is that more and more doctors are leaving private practice," said Tommy Bohannon, Divisional Vice President of Hospital-Based Recruiting for Merritt Hawkins, a physician-recruiting company based in Irving, Texas. "Hospitals and medical groups are offering more competitive salaries to attract physicians. Also, as the economy improves, however slightly, more patients are getting elective procedures they had put off over the past few years."

Some of the major findings from Medscape's 2013 report:

• Orthopedic surgeons again topped the list as the highest earners, with a mean income of $405,000, followed by cardiologists ($357,000) and radiologists ($349,000).

• The lowest-earning specialists were similar to those in Medscape's survey report from last year: internists ($185,000), diabetes physicians/endocrinologists ($178,000), family physicians ($175,000), and pediatricians ($173,000). HIV/infectious disease physicians ($170,000) dropped to the lowest-earning position, which was previously occupied by pediatricians.

• Most physicians posted income gains ranging from modest to significant. Orthopedic surgeons led the field with a 27% boost. Internists had a 9% jump, and family physicians saw a 5% increase. Of the 25 specialties surveyed, only endocrinologists and oncologists saw their incomes decline, by 3% and 4%, respectively.

• The gender gap is narrowing. Overall, male physicians earn 30% more than female colleagues. That's down from 40% the year before. In primary care, the pay gap between men and women narrowed over the past year, from 23% to 17%.

• Healthcare reform is clearly making an impact. In last year's survey, only 8% of physicians were either in an Accountable Care Organization (ACO) or planned to be in one in the coming year; that number jumped to 24% in this year's report.

• For the third consecutive year, physicians in the North Central region earned the most ($259,000), whereas doctors in the Northeast earned the least ($228,000).

• Less than one half of all physicians (48%) believe they are fairly compensated for their work, down from 51% the year before. In primary care, 51% say they are fairly compensated, up from 46% the previous year.

• Although a bare majority (51%) of physicians would still choose medicine as a career, there's been a steady decline in overall satisfaction with the field of medicine. In 2012, 54% of doctors said they'd choose medicine again as a career, whereas 69% said that in 2011. Only 42% of doctors would choose the same specialty again, down from 61% 2 years ago.